Study: More bladder cancer care is no help

WASHINGTON - Patients who get more intensive treatment for early bladder cancer do not fare any better than patients who get less treatment, US researchers reported yesterday.

Medicare, the federal health insurance plan for the elderly, spent more than twice as much on the intensively managed patients without improving their survival rates, Dr. Brent Hollenbeck of the University of Michigan and colleagues found in their study.

The study, published in the Journal of the National Cancer Institute, supports findings that show great variation in how much different hospitals and doctors spend on care, with little indication that spending more helps patients.

"Urologists should not assume that more is necessarily better," Hollenbeck said in a telephone interview.

"We are observing the variation and we are not seeing any benefit with the added treatment. Eliminating unnecessary care is very important. Overuse is a big problem in the US healthcare system."

Bladder cancer affected 68,810 people in 2008 in the United States and killed 14,100, according to the National Cancer Institute. It is more likely to affect men.

Treatment can include surgery, chemotherapy, radiation therapy, and infusion of the bacteria used to vaccinate against tuberculosis. Doctors believe the BCG vaccine for TB somehow stimulate immune cells to attack cancer cells.

Hollenbeck and colleagues used federal data on 20,713 Medicare patients diagnosed with early bladder cancer between 1992 and 2002 by 940 doctors, mostly urologists.